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There seems to be an association between the use of "normal" saline and acute kidney injury (when compared with other IV fluids).
Why would that be?
#medthread #medtwitter #tweetorial
There seems to be an association between the use of "normal" saline and acute kidney injury (when compared with other IV fluids).
Why would that be?
#medthread #medtwitter #tweetorial
2/
We need to first understand 2 things:
💥What is the difference between saline and other "balanced" crystalloid IV fluids?
💥What is the evidence that saline is associated with kidney injury?
We need to first understand 2 things:
💥What is the difference between saline and other "balanced" crystalloid IV fluids?
💥What is the evidence that saline is associated with kidney injury?
3/
💥How is saline different from other "balanced" crystalloid IV fluids?
💡Saline has⬆️levels of Na/Cl
💡Bc of this difference in composition, when used in large volumes saline⬆️serum Cl levels and causes a hyperchloremic metabolic acidosis
bit.ly
💥How is saline different from other "balanced" crystalloid IV fluids?
💡Saline has⬆️levels of Na/Cl
💡Bc of this difference in composition, when used in large volumes saline⬆️serum Cl levels and causes a hyperchloremic metabolic acidosis
bit.ly
4/
💥What is the evidence that saline is associated with renal injury?
There are several studies suggesting this association. Here's one 👇
bit.ly
💥What is the evidence that saline is associated with renal injury?
There are several studies suggesting this association. Here's one 👇
bit.ly
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Because there is significantly more chloride in saline than other IV fluids, let's zoom in and see how that might affect the kidney 👇
Infusing high chloride-containing fluids into dogs decreased renal perfusion and glomerular filtration rate (GFR).
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Because there is significantly more chloride in saline than other IV fluids, let's zoom in and see how that might affect the kidney 👇
Infusing high chloride-containing fluids into dogs decreased renal perfusion and glomerular filtration rate (GFR).
bit.ly
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💥Why would high serum chloride levels decrease renal blood flow and GFR?
The answer involves the macula densa.
💥Why would high serum chloride levels decrease renal blood flow and GFR?
The answer involves the macula densa.
7/
To review:
💡Macula densa cells sense Na/Cl levels in the distal convoluted tubule (DCT)
💡In response to increased Na/Cl levels in the DCT the macula densa decreases renal blood flow and GFR by inducing renal afferent arteriole vasoconstriction
bit.ly
To review:
💡Macula densa cells sense Na/Cl levels in the distal convoluted tubule (DCT)
💡In response to increased Na/Cl levels in the DCT the macula densa decreases renal blood flow and GFR by inducing renal afferent arteriole vasoconstriction
bit.ly
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When exposed to high levels of Cl (and Na) the macula densa cells literally swell.
ncbi.nlm.nih.gov
When exposed to high levels of Cl (and Na) the macula densa cells literally swell.
ncbi.nlm.nih.gov
10/
Along with swelling the macula densa cells release ATP, signalling nearby afferent arterioles to constrict,⬇️renal blood flow and GFR.
This process is called tubuloglomerular feedback, allowing the kidney to regulate its own perfusion
bit.ly
Along with swelling the macula densa cells release ATP, signalling nearby afferent arterioles to constrict,⬇️renal blood flow and GFR.
This process is called tubuloglomerular feedback, allowing the kidney to regulate its own perfusion
bit.ly
So,⬆️Cl sensed by the macula dense leads to⬆️ATP release, which signals afferent renal arterioles to constrict, which⬇️GFR
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Let's summarize:
💡"Normal" saline has⬆️levels of Cl compared w/ other IV crystalloid fluids
💡Increased serum Cl levels⬇️renal blood flow and GFR
💡This occurs because of ATP release from macula densa cells, which causes renal afferent arteriolar vasoconstriction
Let's summarize:
💡"Normal" saline has⬆️levels of Cl compared w/ other IV crystalloid fluids
💡Increased serum Cl levels⬇️renal blood flow and GFR
💡This occurs because of ATP release from macula densa cells, which causes renal afferent arteriolar vasoconstriction
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